Sunday, May 22, 2011

I've been reminded that USMLE part 1 is fast approaching. So I'm reposting my own memories of the test.

And this clip, from the movie "Real Genius". In 30 seconds it summarizes perfectly what studying for USMLE is like.

Anyway...

At the end of the second year of medical school is the USMLE-1 (United States Medical Licensing Boards, Part 1- the name is misleading, several countries use it). This covers every subject from the first 2 years of medical school: Anatomy, Biochemistry, Pathology, Pharmacology, Microbiology, Neuroanatomy, Physiology, Histology, and a few others. 2 years of learning, all in 1 awful test. When I took it the test consisted of 4 sessions spread out over 2 days. Each session had 200 questions, and 3 hours to answer them.

At my school, if you failed the test, you had to take it again. If you failed it twice, your medical career was over (though you still owed your student loans back).

It was the Summer of 1991.

I don't remember the specific dates. But basically, between the time med school ended for the Summer, and the dreaded test, was roughly 1 month. You had 30 days to re-study everything that had taken you 2 years to learn to that point. And pretty much your chances of a career in medicine depended on how you did.

So it was stressful. And, to this day, I still feel for all of you who are out there studying for it now. Any classmate, resident, or attending who tells you they weren't scared is lying.

Within hours of the semester ending, my class had gone into hiding.

I stopped shaving, to save time. My roommate, Enzyme, disconnected our TV, moved it across the room, and piled furniture in front of it.

My days consisted of me getting up at 7:30. I'd either stay at my apartment desk or walk over to campus to find an empty classroom to study in. I'd put in my trusty earplugs and the world around me ceased to exist.

Around noon I'd go back to my apartment for a PBJ, then go study again. At 5 I'd go back to my place for a sandwich, or ramen soup, or Rice-a-Roni. I'd sit out on my balcony and eat, for 15 minutes of relaxation. Or I'd read a book with dinner (Enzyme and I were both reading a single copy of "The Price of Admiralty" by John Keegan. It sat on our kitchen table for the month, and we'd have different eating times so we could share it). I never spent more than 30 minutes on a break. After dinner I'd go back to my desk, or campus. I'd study until around 3 a.m., then go home to sleep for a few hours.

I called my parents a few times. My daily outfit consisted of gym shorts (the short kind, from the 80's), T-shirt, sneakers, and the growing beard. Days blended together. There were no differences between weekends and weekdays. People I encountered were superfluous to my existence. I saw my classmates a few times, and we exchanged glassy-eyed nods as we passed.

I shaved a night or two before the test. I studied until around 11:30 p.m. on the eve of the test, re-reviewing a few last points.

It was weird, like I was living alone on another planet for 30 days. I have no idea what happened in the news that month. I was out-of-touch with everything but my books.

If there's one thing I came out of medical school with, it was this: The realization that there was absolutely, positively, no way you were EVER going to get everything read, studied, and reviewed that you needed to before the test.

And, somehow, when the test was over and the dust had settled, you'd done it. And you'd have no idea how. I still don't.

Vets have to take their licensing exam in the middle of their 4th (and clinical) year. It covers the 3 years of classroom subjects as well as the clinical techniques/case management found better in the 4th year. We had no time off to study for the test. This meant that people on pathology rotation (which was light and required no after hours work) or people on "vacation rotation" had it good. Those that were on large animal, which had overnight ICU duty sandwiched between full 10 hour days had it much worse. The year I took it was the first year it was on computer. As someone that is good at taking standardized tests, this was nice. I didn't have to wait while other people finished the test: I just went on to the next section.

I still remember getting a question on about a dolphin disease and I was like WTF??? At least ask me about something that I *might* run across in practice...even a cougar would have made more sense (yes, I have seen one in general practice).

Good luck, and don't forget to bring your ID! My BIL didn't bring the correct ID when he went to take it two years ago and wound up missing about 45 minutes of the test time because he had to go home and get it. Of course he wound up failing (just by a few questions though) so he had to take it again.

OK, well, this doesn't compare to the USMLE, but I took the advanced biology GRE many years ago. I read entire general bio texts from cover to cover to prepare. In the 4-hour test, there was exactly 1 question that I knew the answer to because of all that reading. I don't remember the question, but the answer was "auxins".

I remember being in that bubble during my entire clerkship year. USMLE seemed like a break by comparison (we take them in the opposite order where I go to school). I also had to juggle meetings with prospective mentors at the same time, which sucked in some ways, but was a much needed break in others. In retrospect, I think I found the MCAT more stressful, but that's probably because I sucked at Physics. But yeah, not a fun test.

Um. Yes. I don't shower much. My social life is on the Internet for study breaks. I measure self-worth by how many questions I've done for the day, and I look forward to bedtime, because it means I can stop studying.

I took my step 1 on June 4th of last year - the 6 months previous to test day were by far the hardest 6 months of my life! I would study, study some more, eat (while studying), sleep (and dream of questions I had gotten wrong), and repeat. I think I developed medstudementia, as my husband calls it. SO glad that's over - so much emphasis is placed on step 1 nowadays, it's totally ridiculous. Now on to tackle step 2...yuck :(

Call me crazy but I don't remember step 1 being all that bad. I would get to school by 830 do some questions, study a section of first aid, repeat until I either felt like eating or working out then back to it until dinner. I actually miss it, there were a lot of mini breaks with people in the study lounge. You'd talk about weird questions you had, what texts were wrong, etc. There was just this sense of comradery that doesn't stay on into clerkships :(

The best thing I ever did in medical school was tutor other students-I don't say that because it helped with Step 1, but it certainly had that effect as well.

By the day of the test, I had been through the neuroscience course material three times, physiology, biochemistry, and clinical medicine twice, and we had just finished pharmacology. So I primarily studied path, micro, and anatomy; the month before the test was not less stressful than the rest of the first two years of medical school, but was not more so either.

Step I of the USMLE definitely brought the realization that there was no way I was going to be able to study everything. However, the American Board of Internal Medicine recert exam drove that point home with a sledgehammer. All of the cramming, all of the stomach-clenching, added to the fun of seeing patients every day and getting hit up for narcotics.

@This littlePiggy:Med school in the US and UK is very different. I've just finished finals, but this friday also have USMLE step 2 - the easy one. I'm putting of STEP 1 until i'm study for MRCP - we just don't get taught (for good reason) half the crap they have to know. Well, not in my medical school anyway. I'm yet to find a single clinician in the UK who's managed a case of Fabry's disease. Or any of the hundreds of other pointless 1 in a million million diseases they pull out of the woodwork for that test. Good times, and good luck all test takers.

I remember studying for my doctoral comprehensive exams...but I had all summer to study for the written part in the fall of '93. Took 5 days at 8 hrs per day to complete the written part. Then about a month later I had to do the orals, which covered the weaker areas of the written part. No way I could have been ready in only 30 days for the written. Four years of coursework reduced to 40 hrs of exams. Gotta love it! LOL

When I was in the US Navy, I attended the Naval Nuclear Power School in Orlando FL. In a six month window they crammed all the science and physics of a two-year nuclear engineering AAS degree into our little minds. At the end, we were given a comprehensive Essay-Only test on the entire course. You had to score an 85% to pass, if memory serves.

Officers had it worse, their six-month course covered a full four year Nuclear Engineering degree.

Bar Exam --similar, but after working full time and going four years at night, I Was run to ground, so spent my time trying to rest and study. What we are willing to put ourselves through--leads to the inevitable If I had to do it over again.

I don't know if other people touched on it, but the exam is computerized (as everything is) these days. Since the computer testing centers only have a small number of computers (7-15, in my experience), only a few people take the exam on any given day. For example, I took it almost a year ago, June 16th, which was relatively early for my class. Most of my class took it somewhere between June 10th and June 29th or so. So while we all weren't studying for the same exact day, we did huddle together in almost exactly the way you described; grabbing food when we could, working out, swapping jokes, etc. It was one of the most depressing times of medical school (which is saying something in and of itself); I think the only reason that those of us who stayed sane did so because of mutual peer support. I'd also venture to guess that, while there is more importance than ever placed on Step 1, there are also better study aides out there that really have it down to a science... as long as you're willing to commit to the time and energy.Loved your post!

Blocks of 200 questions sounds terrible! Thankfully, the test format has changed a bit; it's now seven blocks of 46 questions that each have an hour time limit. It's all computerized now too.

I take mine tomorrow...can't wait to be done! My study experience hasn't been that terrible compared to some of the horror stories, but that's probably because I have a really low study tolerance. I think I've played more guitar and seen more friends than normal since I've been "studying".

I saw that movie about a year before I went to Caltech. It really is a lot like the movie, minus the glamour.

And I had a term like that, minus the screaming. Instead, students left pitiful notes on the Sun lab whiteboard before they dropped the class. "We can't take it anymore." It made it easier for the rest of us to get onto the computers to do our projects.

So yeah, the way someone else simply takes the good spot at the table, that just about captures it.

i think you studied way more then i did. i always relied on the force to take those tests. i went with whatever answer felt the most right. i do remember spending a great deal of time organizing my colored pencils...

Thanks for the re-post Dr. Grumpy! I read the original post a while back, but it really has a whole new sense of commiseration when you're right in the middle of it! I take mine in less than 3 weeks and am starting to get freaked out. So many resources; so little time. Like you, I have also eaten a PB&J for lunch every day during this study period -- no time (or money) for anything else! And I have a daily uniform of jeans + t-shirt (+/- hoodie depending on temperature). But I have been showering (unlike an above poster), and I definitely can't make it on 4 hrs of sleep a night -- that's impressive (or crazy or both). Sundays are my favorite day of the week because I let myself sleep in till 9am. Sweet, sweet Sundays! Lots of luck to all the other studiers out there!

Dr. Grumpy, a serious question comes to mind. Do you think that this test(and others like it) is really the best way to determine whether students know the material?

I'm not denigrating those of you who have taken these tests, but I wonder if there might be a better way.

Further, there is the question of how much memorization is really needed nowadays? For example, I use a calculator in much of my design work. I could do it by hand, and for the simple stuff I do. But for the rest of it, to save time, I use a cheap calculator.

I have been in a cave for four weeks. My 2 year old had fever last night and I would not go near her. I will have to pay for her therapy one day, but I am taking step 1 tomorrow. I had planned to stop studying tonight at 7:00pm to relax and go to bed early. I did not stop studying until 10pm when I finally realized that I was not going to get through everything I wanted to. I logged on to your website for the first time in months and I came across this post. I am so glad I read it. Thank you for your words of encouragement.

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